Multidetector CT angiography in the assessment of peripheral arterial occlusive disease: accuracy in detecting the severity, number, and length of stenoses

Schernthaner, Rüdiger; Stadler, Alfred; Lomoschitz, F.; Weber, Michael; Fleischmann, Dominik; Lämmer, Johannes; Loewe, Christian

doi:10.1007/s00330-007-0822-8

Cited by 102 publications

(62 citation statements)

References 13 publications

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“…High-resolution computed tomography angiography (CTA) or magnetic resonance angiography (MRA) provides detailed assessment of vascular anatomy, disease burden and location, and lesion character depending on the modality used. 12,13 Such imaging can supplement the results of physiological data from segmental leg pressures and pulse volume recordings. 3 Imaging helps localize the lesions targeted for revascularization (which may require invasive hemodynamic confirmation), the selection of appropriate equipment or adjunctive devices, and the choice of arterial access site (ie, antegrade versus retrograde common femoral access, retrograde pedal access, etc).…”

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confidence: 99%

Endovascular Intervention for Peripheral Artery Disease

Thukkani

Kinlay

2015

Circulation Research

228

158

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Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb.

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confidence: 99%

Endovascular Intervention for Peripheral Artery Disease

Thukkani

Kinlay

2015

Circulation Research

228

158

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“…Tačiau, mūsų turimomis žiniomis, nėra duomenų apie 320 pjūvių kompiuterinio tomografo angiografijų jautrumą ir specifiškumą diagnozuojant periferinių arterijų ligą. Literatūroje minima, kad KTA yra jautrus ir specifiškas tyrimas nustatant arterijų stenozes ir atitinka intervencinės angiografijos tyrimo rezultatus [5,9,10,11]. Kituose moksliniuose tyrimuose vertinant kliniškai reikšmingas (didesnes nei 50 proc.…”

Section: Rezultatų Aptarimasunclassified

“…specifiškumas vertinant didesnes nei 70 proc. stenozes, didžiausias šio tyrimo jautrumas ir specifiškumas vertinant išorinės klubinės arterijos pakitimus [9]. Mūsų tyrime nebuvo vertintas KTA tyrimo jautrumas ir specifiškumas, priklausomai nuo vertintojo ar pažeistos arterijos.…”

Section: Rezultatų Aptarimasunclassified

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Pirmoji klinikinė patirtis lsmu kauno klinikose. 320 pjūvių kompiuterinės tomografijos angiografija diagnozuojant apatinių galūnių arterijų ligas

Laukaitis

Buitkus

Velička

et al. 2015

Medicinos Teorija Ir Praktika

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1Lietuvos sveikatos mokslų universiteto Širdies, krūtinės ir kraujagyslių chirurgijos klinika SANTRAUKAReikšminiai žodžiai: arterijų pažeidimas, kompiuterinės tomografijos angiografija, invazinė angiografija. Darbo tikslas. Nustatyti, ar 320 pjūvių kompiuterinė tomografijos angiografija yra patikimas ir tikslus tyrimas nustatant arterijų stenozės laipsnį, esant periferinių arterijų ligai apatinėse galūnėse. Tyrimo medžiaga ir metodai. Įtraukimo kriterijai: pacientai, sergantys periferinių arterijų liga, kuriems atlikta 320 pjūvių kompiuterinės tomografijos angiografija ir invazinė angiografija per mažiau nei 2 savaičių laikotarpį, kuriems tuo laikotarpiu nebuvo taikytas operacinis ar intervencinis gydymas; pakankamos kokybės kompiuterinės tomografijos angiografijos vaizdai. Rezultatai. Įtraukimo kriterijus atitiko ir buvo vertinami 275 apatinių galūnių arterijų segmentai. Invazinės angiografijos tyrime 0-49 proc. stenozė nustatyta 161 segmente (58,5 proc.), 50-69 proc. stenozė -14 segmentų (5,1 proc.), 70-99 proc. stenozė -22 segmentuose (8 proc.), 100 proc. okliuzija -78 segmentuose (28,4 proc.). Kompiuterinės angiografijos tomografijos tyrime 0-49 proc. stenozė nustatyta 162 segmente (58,9 proc.), 50-69 proc. stenozė -9 segmentuose (3,3 proc.), 70-99 proc. stenozė -32 segmentuose (11,6 proc.), 100 proc. okliuzija -72 segmentuose (26,2 proc.). 320 pjūvių kompiuterinės tomografijos angiografijos rezultatai, palyginti su invazine angiografija, sutapo 216 segmentų (78,5 proc.), kappa = 0,63. 320 pjūvių kompiuterinės tomografijos angiografijos jautrumas ir specifiškumas diagnozuojant kliniškai reikšmingą stenozę (> 50 proc.) buvo atitinkamai 90,4 proc. ir 94 proc. 320 pjūvių kompiuterinės tomografijos angiografijos jautrumas nustatant didesnę nei 70 proc. stenozę buvo 91 proc., specifiškumas -93 proc. Išvados. Mūsų tyrimo rezultatai parodė, kad apatinių galūnių 320 pjūvių kompiuterinės tomografijos angiografija nustatyti pakitimai atitiko invazinės angiografijos rezultatus. Nustatyta, kad 320 pjūvių kompiuterinės tomografijos angiografija yra jautrus ir specifiškas tyrimas nustatant arterijų stenozes. ABSTRACTKey words: arterial disease, computed tomography angiography, invasive angiography. Objective. To determine whether 320 slices computed tomography angiography is a reliable test when determining the degree of arterial stenosis in case of peripheral artery disease in lower extremities. Materials and methods. Patients with peripheral artery disease who had 320 slices computed tomography angiography and invasive angiography performed in less than two weeks, to whom surgical or interventional treatment was not applied; computed tomography angiography images of sufficient quality.

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“…In addition, the advent of multislice CT angiography during the last few years has provided a non-invasive alternative for the assessment of stented vessels. The use of modern 16-and 64-slice CT systems was recently proven to significantly improve spatial resolution and lumen visualisation, rendering multidetector CT (MDCT) angiography a powerful tool for ISR assessment [2][3][4][5][6][7][8].…”

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confidence: 99%

Accuracy of multislice CT angiography for the assessment of in-stent restenoses in the iliac arteries at reduced dose: a phantom study

Perisinakis

Manousaki²,

Zourari³

et al. 2011

BJR

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Objective: We investigated the potential of low-dose CT angiography for accurate assessment of in-stent restenoses (ISRs) of the iliac artery. Method: A Rando anthropomorphic phantom (Alderson Research Labs, Stanford, CA), custom-made wax simulating hyperplastic tissue and a nitinol stent were used to simulate a patient with clinically relevant iliac artery ISRs. The cylindrical lumen was filled with a solution of iodine contrast medium diluted in saline, representing a patient's blood during CT angiography. The phantom was subjected to standard-and low-dose angiographic exposures using a modern multidetector (MD) CT scanner. The percentage of ISR was determined using the profile along a line normal to the lumen axis on reconstructed images of 2 and 5 mm slice thickness. Percentage ISRs derived using the standard-and low-dose protocols were compared. In a preliminary study, seven patients with stents were subjected to standard-and low-dose MDCT angiography during followup. The resulting images were assessed and compared by two experienced radiologists. Results: The accuracy in measuring the percentage ISR was found to be better than 12% for all simulated stenoses. The differences between percentage ISRs measured on images obtained at 120 kVp/160 mAs and 80 kVp/80 mAs were below 6%. Patient image sets acquired using low-exposure factors were judged to be of satisfactory diagnostic quality. The assessment of ISR did not differ significantly between image sets acquired using the standard factors and those acquired using the low-exposure factors, although the mean reduction in patient effective dose was 48%. Conclusion: A reduction in exposure factors during MDCT angiography of the iliac artery is possible without affecting the accuracy in the determination of ISRs.

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Multidetector CT angiography in the assessment of peripheral arterial occlusive disease: accuracy in detecting the severity, number, and length of stenoses

Cited by 102 publications

References 13 publications

Endovascular Intervention for Peripheral Artery Disease

Endovascular Intervention for Peripheral Artery Disease

Pirmoji klinikinė patirtis lsmu kauno klinikose. 320 pjūvių kompiuterinės tomografijos angiografija diagnozuojant apatinių galūnių arterijų ligas

Accuracy of multislice CT angiography for the assessment of in-stent restenoses in the iliac arteries at reduced dose: a phantom study

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